CHRONIC LEG ULCERS

DEFINITION
Discontinuity of epithelium/ mucous membrane of certain area

CHARACTER OF ULCER
1.
2.
3.
4.

Site
Size
Shape
Number

5.
6.
7.
8.

Edge
Margin
Base
Floor

9. Discharge
10. Lymph node

CAUSES
PRIMARY
1. TRAUMATIC: Non-specific leg ulcer
2. INFLAMMATORY: TB, syphilis, tropical ulcer,
diphteritic ulcer, leshmaniasis
3. NEOPLASTIC: SCC, BCC, Margolins ulcer,
ulcerating melanoma, Kaposi sarcoma

1.
2.
3.

4.
5.

SECONDARY
ARTERIES: Ischemic ulcers
VEINS: Venous ulcer
(varicose vein, post-phlebitic)
NERVES: Polyneuropathy, DM, leprosy, peripheral
nerve injury, tabes dorsalis, transverse myelitis,
spine trauma
LYMPHATICS: Chronic lymphedema complication
SYSTEMIC: Hemolytic anemia, ulcerative colitis,
systemic HTN, malnutrition

DIFFERENTIAL DIAGNOSIS
SITE
Above the medial malleolus

VENOUS ULCER
Varicose ulcer
Post-phlebitic ulcer

CHARACTER
Irregular shaped
Surrounded by halo of pigmentation & ankle flare
Shallow floor with punched out / elevated edge &
seropurulent discharge
Base covered with yellow fibrous tissue
(unhealthy granulation tissue)
Shape: Rounded/ skip patches
Edge: Punched out
Surrounding skin: Dry, cold, pale, shiny & hairless
Base: Dry, necrotic with little/ no granulation & no
bleed
Typically very painful usually at night

No: Single
Size & shape: variable
Margin: +/- pigmentation
Edge: Punched out Sloping (if healed)
Floor: Covered by granulation tissue
Discharge: Serous/purulent
Base: Raised

On the feet distally & over bony

prominences (toe & foot)
ARTERIAL ULCER

Etiology: Wound, burn, radiation,

bed sore
TRAUMATIC ULCER
Site: Chin of tibia

TB: Metaphysis of tibia

Size & shape: variable

Margin: Cynotic
Edge: Undetermined
Floor: Caseous material
Base: Soft
Discharge: Serous

Syphilis: Middle 2/4 of tibia

Edge: Punched out

Floor: Wash-leather slough

Margolin: Sq. cell carcinoma on

top of chr. scar/ulcer

Raised everted edge & hard fixed base

Painless

Kaposi sarcoma: Malignant

tumor of vascular endothelial cells

Color: Bluish red nodules in skin & mm

INFLAMMATORY
ULCER

NEOPLASTIC ULCER

TREATMENT
1.
2.
3.
4.
5.

6.

Self care: Keep mobile, regular walking, leg elevation

Wound dressing
Antibotic & pain reliever
Surgical: Ligation, vein valve transplant, veno-venous bypass
Skin graph
Amputation